That’s the question posed in tonight’s 20/20 programme* that investigates the phenomena of women reporting orgasmic experiences during labour.

Already the programme has invited a fair bit of controversy with many reacting to it with either disbelief or disgust. You can see a range of typical reactions following the Huffington Post’s report on the documentary in their comments section.

Orgasmic experiences during labour do happen, but they are rare. It is difficult to know how many women do have these experiences since many are so surprised by them they do not admit to having them. Most research on this area has not really addressed the orgasmic experience of labour making it difficult to know the full range of experiences women have during childbirth. Instead studies on orgasm either focus on the role of orgasm in bringing on labour or speeding it up, or on post-partum sexual dysfunction.

As this is a pretty neglected area of research studies tend to be fairly limited and often rely on either observational reports from clinicians or surveys from women or healthcare professionals asking them to recall information about orgasm pre or post birth.

We’ve not focused much on pleasure during birth partly because other areas of birth have had a greater focus (particularly negative but important topics of premature labour, problematic labour or post-partum complications). Another reason this area has not been investigated is it would require following up large numbers of women and asking them to talk about their births which although worthwhile would be an expensive study in an area that sadly isn’t seen as a research priority.

It is well documented that intercourse and orgasm do seem to help bring on labour (although not in all cases), and clitoral and/or nipple stimulation can help speed up a labour that has slowed or stopped. However, not all women feel comfortable with this and certainly it takes a confident woman to announce she wants to stimulate her breasts or clitoris during labour (or have a go at doing this). Supportive midwives can encourage this, but not all do so.

Women can have an orgasm through direct clitoral or nipple stimulation (by themselves, a partner or midwife) during any stage of labour, but it is most commonly introduced in the early stages and may well be helpful as a form of pain relief during the first stage of labour. A limited number of studies also suggest that women may experience a vaginal orgasm during the second stage of labour as the baby moves down the birth canal and presses on the walls of the vagina.

However, it is unclear exactly what is meant by ‘orgasmic birth’ since women who have had this experience tend to talk about sensations that range from feeling spiritually connected to the universe, feeling outside their bodies, being ‘blissed out’, or having intense spasms within the vagina and sometimes down their legs or up their backs. Since definitions vary it may be more women have an ‘orgasmic experience’ but don’t name it as such.

Taboos around sexuality and motherhood mean many are afraid to say if they’ve had such an experience – fearing they may be seen as abusive or exploitative of their baby. Mothers are expected to be pure, not lustful creatures (which is why so many women experience post-birth sex problems). That said, most women who have orgasmic experiences during labour and birth often describe intensely pleasurable physical sensations that are far more than sexual.

Advocates of sharing the orgasmic birth message claim that it helps free women from seeing birth as something they are not in control of, and that has to be painful, medical and distressing. Showing that birth can feel pleasurable is a way they think can empower women towards more active and natural births. They want to demystify the experience they call ‘birthgasm’.

Critics argue that orgasmic birth experiences are rare, and setting them up as something to aim for will put more pressure on mothers to have an ‘ideal’ birth. They worry that women who don’t have an orgasmic birth experience will feel cheated or as having ‘failed’ in some way. With so much pressure for women to be perfect mothers and go for cosmetic ‘mummy makeovers’ the message that you ought to be coming while you deliver could be yet another level of stress. There is also the concern that introducing sexual stimulation with a partner may not always be what both parties want and may be particularly problematic if the mother wants to focus on birth but her partner wants to start with kissing or cuddles.

Some birth specialists have praised the programme, arguing it will expose a hidden secret about birth that should be shared and celebrated. Others have expressed the worry that the programme has missed an opportunity for promoting active or natural birth in favour of a far more unusual event that seems to happen more by accident than design.

It is worth noting that where women describe orgasmic birth experiences they are usually those who have had a natural and uncomplicated birth requiring no medical intervention and no follow up problems. Clearly those women who have opted for natural or active births within birth centres and home settings and who have supportive midwives or doulas present are not representative of all women or their birth experiences.

Such women are lucky, but sometimes their messages are based on their experiences and do not take into account how other births might be. In such cases they may imply that those who don’t achieve a natural, active or orgasmic birth didn’t manage this through a lack of motivation, skill, or commitment – which can leave many mums feeling inadequate or guilty if they didn’t aspire to or manage to have such a birthing experience.

Midwives, health visitors, obstetricians and affiliated healthcare staff as well as parents-to-be do all need information about the varied ways women can experience birth. Giving women and their partners’ information on the kinds of things to expect – positive and negative, and how to manage labour, can undoubtedly help women relax and reduce anxiety-related problems in labour.

While we need to let women know that sexual stimulation can help before and during labour, and that labour can be painful, pleasurable, or both, we shouldn’t set up ideal standards for birth. It’s wrong to promote medicalised birth, just as it is unhelpful to imply anyone who’s not had a ‘natural’ birth has failed. It’s also wrong to suggest that orgasms should be mandatory during labour or to make women feel dirty if they do experience orgasm.

Empowering women to experience sensual pleasure during the birth process should be part of preparing for birth education, acknowledging that this may not appeal to everyone. We also need more research about this experience within labour to find out more about different experiences and have a clearer picture of the process of birth. If I hear of any research on this topic I’ll let you know.

Somehow I think we’re a long way from sorting that kind of messaging out for women, and so even though I think the 20/20 programme is tackling some extreme examples sometimes we do need cases like this to remind us how varied birth can be so that if a woman does experience pleasure she can embrace that and not feel dirty or ashamed.